Stage 4 stomach cancer

Staging systems

Doctors use different systems to stage stomach cancer. This page is about stage 4 cancer, which is part of the number staging system. This system has 5 stages, stage 0 (high grade dysplasia) to stage 4.

This page also tells you what stage 4 means in the TNM system. This system describes:

• the size of the primary tumour (T)

• whether the cancer has spread to the lymph nodes (N)

• whether the cancer has spread to another part of the body (M)

Read more about TNM staging for stomach cancer

How do doctors find out your stage?

There are different ways to find out your stage. Your doctor might use:

• clinical staging before treatment and if you don't have surgery

• pathological staging if you do have surgery

• post neoadjuvant staging if you have chemotherapy before surgery

Clinical staging means the doctor stages you after examining you and looking at test and scan results. Doctors use clinical staging to plan your treatment. It’s also the best way to stage people who aren’t having surgery. You might see your clinical stage written as cTNM.

Pathological staging means the doctor stages you after examining the tissue that the surgeon removes during an operation. This is also called surgical staging. The doctors combine your clinical stage results with the surgical results. Pathological staging is generally a more precise way to find out how far your cancer has spread. Your pathological stage might be different to your clinical stage. You might see your pathological stage written as pTNM.

Post neoadjuvant staging means you have had chemotherapy before surgery (neoadjuvant treatment) and the doctor stages you again after surgery. You might see your post neoadjuvant stage written as ypTNM. 

For stomach cancer, the clinical, pathological, and post neoadjuvant staging are all different. In this section we describe the pathological and clinical stages.

What is stage 4 stomach cancer (clinical staging)?

In clinical staging, stage 4 stomach cancer is divided into 2 groups - stage 4A and stage 4B.

Stage 4A means your cancer has grown through the stomach wall and into nearby organs or tissues. It might have spread to nearby lymph nodes but it hasn’t spread to distant body parts. This is sometimes called locally advanced cancer.

In the TNM system, stage 4A is the same as:

• T4b, any N, M0

Stage 4B means your cancer has spread to distant body parts. This spread is called advanced, metastatic or secondary cancer.

What is stage 4 stomach cancer (pathological staging)?

Pathological staging means the doctor stages you after examining the tissue that the surgeon removes during an operation. 

In pathological staging, stage 4 stomach cancer means your cancer has spread to distant body parts. This spread is called advanced, metastatic or secondary cancer.

In the TNM system, stage 4 is the same as:

• Any T, any N, M1

Where stomach cancer spreads

Cancer can spread to different parts of the body. Stomach cancer is more likely to spread to the: 

• liver

• lungs

• tissue lining the abdominal cavity (peritoneum)

Find out more about secondary cancer

Treatment

The stage of your cancer helps your doctor to decide what treatment you need. Treatment also depends on:

• your type of cancer (the type of cells the cancer started in)

• where the cancer is in your stomach

• other health conditions

Treatment for stage 4 aims to control the cancer and maintain a good quality of life. You might have:

• chemotherapy

• radiotherapy

• surgery to control symptoms

• symptom control, for example treatment to help you swallow food

• targeted or immunotherapy cancer drugs

Find out about treatment for advanced cancer

About other stages

• High grade dysplasia

• Stage 1

• Stage 2

• Stage 3